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Concept: Methodology

168

BACKGROUND: Educational computer games are examples of computer-assisted learning objects, representing an educational strategy of growing interest. Given the changes in the digital world over the last decades, students of the current generation expect technology to be used in advancing their learning requiring a need to change traditional passive learning methodologies to an active multisensory experimental learning methodology. The objective of this study was to compare a computer game-based learning method with a traditional learning method, regarding learning gains and knowledge retention, as means of teaching head and neck Anatomy and Physiology to Speech-Language and Hearing pathology undergraduate students. METHODS: Students were randomized to participate to one of the learning methods and the data analyst was blinded to which method of learning the students had received. Students' prior knowledge (i.e. before undergoing the learning method), short-term knowledge retention and long-term knowledge retention (i.e. six months after undergoing the learning method) were assessed with a multiple choice questionnaire. Students' performance was compared considering the three moments of assessment for both for the mean total score and for separated mean scores for Anatomy questions and for Physiology questions. RESULTS: Students that received the game-based method performed better in the pos-test assessment only when considering the Anatomy questions section. Students that received the traditional lecture performed better in both post-test and long-term post-test when considering the Anatomy and Physiology questions. CONCLUSIONS: The game-based learning method is comparable to the traditional learning method in general and in short-term gains, while the traditional lecture still seems to be more effective to improve students' short and long-term knowledge retention.

Concepts: Scientific method, Head and neck anatomy, Biology, Education, Anatomy, Learning, Human anatomy, Methodology

168

BACKGROUND: Treatment burden can be defined as the self-care practices that patients with chronic illness must perform to respond to the requirements of their healthcare providers, as well as the impact that these practices have on patient functioning and well being. Increasing levels of treatment burden may lead to suboptimal adherence and negative outcomes. Systematic review of the qualitative literature is a useful method for exploring the patient experience of care, in this case the experience of treatment burden. There is no consensus on methods for qualitative systematic review. This paper describes the methodology used for qualitative systematic reviews of the treatment burdens identified in three different common chronic conditions, using stroke as our exemplar. METHODS: Qualitative studies in peer reviewed journals seeking to understand the patient experience of stroke management were sought. Limitations of English language and year of publication 2000 onwards were set. An exhaustive search strategy was employed, consisting of a scoping search, database searches (Scopus, CINAHL, Embase, Medline & PsycINFO) and reference, footnote and citation searching. Papers were screened, data extracted, quality appraised and analysed by two individuals, with a third party for disagreements. Data analysis was carried out using a coding framework underpinned by Normalization Process Theory (NPT). RESULTS: A total of 4364 papers were identified, 54 were included in the review. Of these, 51 (94%) were retrieved from our database search. Methodological issues included: creating an appropriate search strategy; investigating a topic not previously conceptualised; sorting through irrelevant data within papers; the quality appraisal of qualitative research; and the use of NPT as a novel method of data analysis, shown to be a useful method for the purposes of this review. CONCLUSION: The creation of our search strategy may be of particular interest to other researchers carrying out synthesis of qualitative studies. Importantly, the successful use of NPT to inform a coding frame for data analysis involving qualitative data that describes processes relating to self management highlights the potential of a new method for analyses of qualitative data within systematic reviews.

Concepts: Scientific method, Medicine, Patient, Data analysis, Qualitative research, Peer review, Normalization Process Theory, Methodology

165

To evaluate the clinical effectiveness of weight management interventions in adults with intellectual disabilities (ID) and obesity using recommendations from current clinical guidelines for the first line management of obesity in adults. Full papers on lifestyle modification interventions published between 1982 to 2011 were sought by searching the Medline, Embase, PsycINFO and CINAHL databases. Studies were evaluated based on 1) intervention components, 2) methodology, 3) attrition rate 4) reported weight loss and 5) duration of follow up. Twenty two studies met the inclusion criteria. The interventions were classified according to inclusion of the following components: behaviour change alone, behaviour change plus physical activity, dietary advice or physical activity alone, dietary plus physical activity advice and multi-component (all three components). The majority of the studies had the same methodological limitations: no sample size justification, small heterogeneous samples, no information on randomisation methodologies. Eight studies were classified as multi-component interventions, of which one study used a 600 kilocalorie (2510 kilojoule) daily energy deficit diet. Study durations were mostly below the duration recommended in clinical guidelines and varied widely. No study included an exercise program promoting 225–300 minutes or more of moderate intensity physical activity per week but the majority of the studies used the same behaviour change techniques. Three studies reported clinically significant weight loss (>= 5%) at six months post intervention. Current data indicate weight management interventions in those with ID differ from recommended practice and further studies to examine the effectiveness of multi-component weight management interventions for adults with ID and obesity are justified.

Concepts: Nutrition, Obesity, Physical exercise, Overweight, Weight loss, Methodology, Dieting, Physical fitness

59

Dengue is a mosquito-borne disease that threatens over half of the world’s population. Despite being endemic to more than 100 countries, government-led efforts and tools for timely identification and tracking of new infections are still lacking in many affected areas. Multiple methodologies that leverage the use of Internet-based data sources have been proposed as a way to complement dengue surveillance efforts. Among these, dengue-related Google search trends have been shown to correlate with dengue activity. We extend a methodological framework, initially proposed and validated for flu surveillance, to produce near real-time estimates of dengue cases in five countries/states: Mexico, Brazil, Thailand, Singapore and Taiwan. Our result shows that our modeling framework can be used to improve the tracking of dengue activity in multiple locations around the world.

Concepts: Infectious disease, Earth, Fever, Web search engine, Methodology, Pandemic, Tracking, World population

59

The existence of episodic memory in non-human animals is a debated topic that has been investigated using different methodologies that reflect diverse theoretical approaches to its definition. A fundamental feature of episodic memory is recalling after incidental encoding, which can be assessed if the recall test is unexpected [1]. We used a modified version of the “Do as I Do” method [2], relying on dogs' ability to imitate human actions, to test whether dogs can rely on episodic memory when recalling others' actions from the past. Dogs were first trained to imitate human actions on command. Next, they were trained to perform a simple training exercise (lying down), irrespective of the previously demonstrated action. This way, we substituted their expectation to be required to imitate with the expectation to be required to lie down. We then tested whether dogs recalled the demonstrated actions by unexpectedly giving them the command to imitate, instead of lying down. Dogs were tested with a short (1 min) and a long (1 hr) retention interval. They were able to recall the demonstrated actions after both intervals; however, their performance declined more with time compared to conditions in which imitation was expected. These findings show that dogs recall past events as complex as human actions even if they do not expect the memory test, providing evidence for episodic-like memory. Dogs offer an ideal model to study episodic memory in non-human species, and this methodological approach allows investigating memory of complex, context-rich events.

Concepts: Memory, Methodology, Episodic memory, Recall election, Lie

33

As general living standards rise, so does the demand for periodic general health examinations (GHEs). Research on the subject, however, has reached opposing conclusions on the value of GHEs, although methodological limitations in previous works make these differences hard to resolve. Here, we present data from a socio-demographic survey of behaviours and tendencies concerning periodic GHE attendance in Vietnam. These data are shown to be suitable for evaluating the impact of demographic and socio-economic elements on regular health examinations. By presenting the methods used in this survey and by describing the enquiries mentioned in the dataset, this article aims to promote data-collecting methodologies that can help policy-makers and health communicators derive practical conclusions.

Concepts: Scientific method, Psychology, Epistemology, Data, Subject, Methodology, Vietnam, Socioeconomics

31

Self-assembly of block-copolymers provides a route to the fabrication of small (size, <50 nm) and dense (pitch, <100 nm) features with an accuracy that approaches even the demanding specifications for nanomanufacturing set by the semiconductor industry. A key requirement for practical applications, however, is a rapid, high-resolution method for patterning block-copolymers with different molecular weights and compositions across a wafer surface, with complex geometries and diverse feature sizes. Here we demonstrate that an ultrahigh-resolution jet printing technique that exploits electrohydrodynamic effects can pattern large areas with block-copolymers based on poly(styrene-block-methyl methacrylate) with various molecular weights and compositions. The printed geometries have diameters and linewidths in the sub-500 nm range, line edge roughness as small as ∼45 nm, and thickness uniformity and repeatability that can approach molecular length scales (∼2 nm). Upon thermal annealing on bare, or chemically or topographically structured substrates, such printed patterns yield nanodomains of block-copolymers with well-defined sizes, periodicities and morphologies, in overall layouts that span dimensions from the scale of nanometres (with sizes continuously tunable between 13 nm and 20 nm) to centimetres. As well as its engineering relevance, this methodology enables systematic studies of unusual behaviours of block-copolymers in geometrically confined films.

Concepts: Geometry, Semiconductor, Pattern, Methodology, Printing, Inkjet printer, Annealing

29

PARLOUR R and MCCORMACK B. Nursing Inquiry 2012; 19: 308-321 Blending critical realist and emancipatory practice development methodologies: making critical realism work in nursing research This paper examines the efficacy of facilitation as a practice development intervention in changing practice within an Older Person setting and in implementing evidence into practice. It outlines the influences exerted by the critical realist paradigm in guiding emancipatory practice development activities and, in particular, how the former may be employed within an emancipatory practice development study to elucidate and increase understanding pertinent to causation and outcomes. The methodology is based upon an emancipatory practice development approach set within a realistic evaluation framework. This allows for systematic analysis of the social and contextual elements that influence the explication of outcomes associated with facilitation. The study is concentrated upon five practice development cycles, within which a sequence of iterative processes is integrated. The authors assert that combining critical realist and emancipatory processes offers a robust and practical method for translating evidence and implementing changes in practice, as the former affirms or falsifies the influence that emancipatory processes exert on attaining culture shift, and enabling transformation towards effective clinical practice. A new framework for practice development is proposed that establishes methodological coherency between emancipatory practice development and realistic evaluation. This augments the existing theoretical bases for both these approaches by contributing new theoretical and methodological understandings of causation.

Concepts: Scientific method, Critical thinking, Epistemology, Philosophy of science, Methodology, Realism, Critical realism, Transcendental realism

29

PURPOSE: Despite the importance of leadership in interprofessional health care teams, little is understood about how it is enacted. The literature emphasizes a collaborative approach of shared leadership, but this may be challenging for clinicians working within the traditionally hierarchical health care system. METHOD: Using case study methodology, the authors collected observation and interview data from five interprofessional health care teams working at teaching hospitals in urban Ontario, Canada. They interviewed 46 health care providers and conducted 139 hours of observation from January 2008 through June 2009. RESULTS: Although the members of the interprofessional teams agreed about the importance of collaborative leadership and discussed ways in which their teams tried to achieve it, evidence indicated that the actual enactment of collaborative leadership was a challenge. The participating physicians indicated a belief that their teams functioned nonhierarchically, but reports from the nonphysician clinicians and the authors' observation data revealed that hierarchical behaviors persisted, even from those who most vehemently denied the presence of hierarchies on their teams. CONCLUSIONS: A collaborative approach to leadership may be challenging for interprofessional teams embedded in traditional health care, education, and medical-legal systems that reinforce the idea that physicians sit at the top of the hierarchy. By openly recognizing and discussing the tensions between traditional and interprofessional discourses of collaborative leadership, it may be possible to help interprofessional teams, physicians and clinicians alike, work together more effectively.

Concepts: Health care, Medicine, Healthcare, Hospital, Hierarchy, Methodology, Heterarchy, Maslow's hierarchy of needs

28

A new form of augmentative and alternative communication (AAC) device for people with severe speech impairment-the voice-input voice-output communication aid (VIVOCA)-is described. The VIVOCA recognizes the disordered speech of the user and builds messages, which are converted into synthetic speech. System development was carried out employing user-centered design and development methods, which identified and refined key requirements for the device. A novel methodology for building small vocabulary, speaker-dependent automatic speech recognizers with reduced amounts of training data, was applied. Experiments showed that this method is successful in generating good recognition performance (mean accuracy 96%) on highly disordered speech, even when recognition perplexity is increased. The selected message-building technique traded off various factors including speed of message construction and range of available message outputs. The VIVOCA was evaluated in a field trial by individuals with moderate to severe dysarthria and confirmed that they can make use of the device to produce intelligible speech output from disordered speech input. The trial highlighted some issues which limit the performance and usability of the device when applied in real usage situations, with mean recognition accuracy of 67% in these circumstances. These limitations will be addressed in future work.

Concepts: The Trial, Methodology, Input, Message, Output, Usability, Input/output, Augmentative and alternative communication